1558607150 NPI number — KATHERINE S PAK, DDS PLLC

Table of content: (NPI 1558607150)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1558607150 NPI number — KATHERINE S PAK, DDS PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
KATHERINE S PAK, DDS PLLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
ELAINE R. MCNEIGHT, DDS PLLC
Provider Other Organization Name Type Code:
5
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1558607150
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/31/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2135 AYRSLEY TOWN BLVD
Provider Second Line Business Mailing Address:
SUITE F
Provider Business Mailing Address City Name:
CHARLOTTE
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28273-3541
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
980-297-7071
Provider Business Mailing Address Fax Number:
980-297-7074

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2135 AYRSLEY TOWN BLVD
Provider Second Line Business Practice Location Address:
SUITE F
Provider Business Practice Location Address City Name:
CHARLOTTE
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28273-3541
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
980-297-7071
Provider Business Practice Location Address Fax Number:
980-297-7074
Provider Enumeration Date:
12/31/2012

Additional Information

Authorized Official

Authorized Official Last Name:
PAK
Authorized Official First Name:
KATHERINE
Authorized Official Middle Name:
Authorized Official Title or Position:
MEMBER
Authorized Official Telephone Number:
980-297-7071

Provider Taxonomy Codes

  • Taxonomy code: 122300000X , with the licence number:  7592 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 122300000X , with the licence number: 8706 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)





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